MR. CHRISTOPHER DOMINICK ELLIS (CRNP) – Family Nurse Practitioner, NPI 1366026361

MR. CHRISTOPHER DOMINICK ELLIS (CRNP) is a healthcare provider. based in Shavertown, Pennsylvania. specializing in NURSE PRACTITIONER. They hold the professional credentials CRNP. They hold a License No. SP023586 (PA). The NPI Number for MR. CHRISTOPHER DOMINICK ELLIS (CRNP) is 1366026361

Main info

Male
Sole Proprietor
5 Years Of Experience
Accepts Medicare Assignment
Name
MR. CHRISTOPHER DOMINICK ELLIS (CRNP)
NPI
1366026361
Phone
(570) 606-7972
Address
1160 LANTERN HILL RD
Enumeration Date
6 May 2021
Last Update Date
6 May 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5708231111
Graduation Year
2021 (5 years ago)
PAC ID
6103226220
Group Practice PAC ID
1052384658
Professional Enrollment ID
I20210611000127
Address ID
PA187051012PL667XXSTXX401
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience34
Completeness75
Years active:5State licenses:1Digital endpointsOther names

11,473 NURSE PRACTITIONER in PA

Provider Addresses for MR. CHRISTOPHER DOMINICK ELLIS (CRNP)

  • 1160 LANTERN HILL RD

    SHAVERTOWN, PA 187089590

    Phone: (570) 606-7972

    Type: Mailing

  • 667 N RIVER ST #201

    PLAINS, PA 187051870

    Phone: (570) 823-1111

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 201 Open Payments records for all available years, with a total value of $3,381.

Total Amount is formed as General ($3,381) + Research ($0) + Ownership ($0) = $3,381.

Last reported payment date: 2024-12-12 • Largest payer in this snapshot: Novartis Pharmaceuticals Corporation ($560).

Total Amount

$3,381

General + Research + Ownership

Payments

201

Total payment records

General Amount

$3,381

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-12

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2021-06-11

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20210611000127INurse PractitionerPATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 18708)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1052384658View full group profile
NameSpecialtyState
Nurse PractitionerPA
Interventional Cardiology, Cardiovascular Disease (Cardiology)PA
Cardiovascular Disease (Cardiology), Internal MedicinePA
Cardiovascular Disease (Cardiology), Internal MedicinePA
Cardiac Electrophysiology, Cardiovascular Disease (Cardiology)PA

Reviews

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Frequently asked questions

What unique ID ties claims to MR. CHRISTOPHER DOMINICK ELLIS (CRNP)?
NPI 1366026361 is assigned to MR. CHRISTOPHER DOMINICK ELLIS (CRNP) under the national enumeration system.
Does this profile mean MR. CHRISTOPHER DOMINICK ELLIS (CRNP) is currently active?
Yes — MR. CHRISTOPHER DOMINICK ELLIS (CRNP) appears active in the national provider directory.
Does MR. CHRISTOPHER DOMINICK ELLIS (CRNP) list a primary specialty?
If you are matching referrals, note Family Nurse Practitioner for MR. CHRISTOPHER DOMINICK ELLIS (CRNP). Clinical services aligned with this taxonomy classification.
Where is MR. CHRISTOPHER DOMINICK ELLIS (CRNP)'s primary listing?
We display Shavertown, Pennsylvania because that is what the record indicates for MR. CHRISTOPHER DOMINICK ELLIS (CRNP).
How can I contact MR. CHRISTOPHER DOMINICK ELLIS (CRNP)?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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